Real-world analyses of therapy discontinuation of checkpoint inhibitors in metastatic melanoma patients

Academic Article


  • The ‘real-world’ patient population of metastatic melanoma is not fully represented in clinical trials investigating checkpoint inhibitors. We described therapy discontinuation in an unselected population-based cohort of adults with metastatic melanoma who started therapy with pembrolizumab, nivolumab, or nivolumab/ipilimumab from January 2015 to August 2017. Therapy discontinuation was defined as a gap between doses beyond 120 days, and/or initiation of another cancer therapy. We estimated drug-specific rate ratios for therapy discontinuation adjusted for age, sex, comorbidities, health care use, and past cancer therapies. We included 876 metastatic melanoma patients initiating pembrolizumab (44.3%), nivolumab/ipilimumab (31.2%), and nivolumab (24.5%). At 12 months of follow-up, the probabilities of therapy discontinuation were 49.9% (95% confidence interval, CI 43.6–56.5) for pembrolizumab, 58.8% (95% CI 50.5–67.3) for nivolumab, and 59.2% (95% CI 51.7–66.8) for nivolumab/ipilimumab. Stratified analyses based on prior cancer therapy, brain metastases at baseline, and sex showed similar trends. In multivariable analyses, compared with pembrolizumab, patients starting nivolumab (rate ratio 1.38, 95% CI 1.08–1.77) or nivolumab/ipilimumab (rate ratio 1.30, 95% CI 1.02–1.65) were more likely to discontinue therapy. Our findings indicate frequent discontinuations of checkpoint inhibitors at one year. The lower discontinuation associated with pembrolizumab should be confirmed in further studies.
  • Published In

  • Scientific Reports  Journal
  • Digital Object Identifier (doi)

    Author List

  • Machado MADÁ; de Moura CS; Chan K; Curtis JR; Hudson M; Abrahamowicz M; Jamal R; Pilote L; Bernatsky S
  • Volume

  • 10
  • Issue

  • 1